Highly skilled perinatologists, neonatologists and other caregivers at WellSpan York Hospital work hand in hand to offer patients facing difficult pregnancies and complex deliveries in South Central Pennsylvania expert care before and after delivery.
Lucie Moravia, DO, perinatologist, WellSpan Maternal-Fetal Medicine, works with Karen King, Ultrasound Technologist, to check on a mother and her baby.
Here, perinatologists monitor mother and infant, prolonging pregnancy as long as is feasible to protect the health of both. The physicians are in constant contact with their counterparts — the neonatologist in the hospital’s recently expanded Level 3 NICU — discussing potential advantages of postponing birth and ready to care for premature babies when the optimal delivery time arrives.
“That’s essentially the art of perinatology: the delicate point at which you decide to deliver the baby,” says Lucie Moravia, DO, FACOG, FACOOG, perinatologist with WellSpan Maternal-Fetal Medicine, a specialized practice that works with the OB-GYN team. “We try to optimize both the mother and baby’s health before we deliver.”
The process begins with advanced ultrasound technology that provides accurate fetal echocardiograms and other imaging, including detailed fetal anatomy surveys. This allows approximately 20 sonographers on the team to monitor the stress on the infant.
To safeguard the mother’s health, the perinatal diabetic team includes a diabetic educator and dietitian. Clinicians also closely monitor mothers for conditions such as hypertension and preeclampsia.
“Maternal-Fetal Medicine and the NICU work like a complex, intimate unit; there are a lot of players, but we all have access to each other and very good communication.”
— Lucie Moravia, DO, FACOG, FACOOG, a perinatologist at WellSpan Maternal-Fetal Medicine
No More Bed Rest
The overarching goal is to prolong pregnancy as long as possible to allow the best possible outcome for the baby, while also stabilizing the mother’s health. A common assumption is that this means bed rest for the mother. That’s no longer the case, Dr. Moravia says, citing an array of pharmacological and surgical options to help prevent the onset of labor. Drug-based options include a weekly shot of 17 AHP, a form of progesterone, which is injected intramuscularly starting as early as 16 weeks of gestation and can reduce preterm births by up to 30 percent. For women who have a short cervix or previously gave birth preterm, a cerclage — a cervical suture — is an effective option, preventing premature birth 80 percent of the time, according to a study published in the Journal of Pregnancy and Child Health.
Postponement of delivery is not always possible, however, so Dr. Moravia and other perinatologists at WellSpan also take prophylactic measures to boost the health of the baby, including administering betamethasone to bolster fetal lung viability and magnesium sulfate to prevent intraventricular hemorrhage in the brain and cerebral palsy.
“We make a huge impact on the families. … Sometimes you see patients years down the road and their families have done such a great job with them. And you know you had that chance to make a difference right from the beginning.”
— Sheela Moorthy, MD, FAAP, a neonatologist at WellSpan York Hospital
Transfer to NICU
The rooms for inpatient treatment of patients facing high-risk pregnancies and the postpartum rooms are adjacent to the NICU, so communication between the perinatal and neonatal teams is seamless. The NICU has specialized equipment scaled small enough to cradle even the tiniest patients and has treated newborns as young as 23 weeks old and only 340 grams in weight, says Sheela Moorthy, MD, FAAP, a neonatologist at WellSpan York Hospital.
With a Level 3 NICU designation, the hospital is able to perform an expansive range of complex surgeries and provide a broad spectrum of advanced treatments. A key therapy that WellSpan offers is total body cooling, which is vital for babies asphyxiated at birth. For a few extremely complex treatments and procedures, such as extracorporeal membrane oxygenation or cardiac surgeries for newborns, WellSpan’s pediatric surgery collaboration with Johns Hopkins Medicine in Baltimore provides access to world-class specialists. Johns Hopkins is only an hour away, and patients can frequently recover in York after procedures in Baltimore.
Alongside critical care are therapies provided to help babies born early acquire all the skills they need to transition safely to home. Family members partner with a support team to help babies learn to move and eat.
“We have three lactation specialists in the NICU,” Dr. Moorthy says. “To be able to breastfeed gives mothers a reassuring sense of control.”
The expansion of the NICU in June was designed with families in mind, with more space for the mother, in particular, to be nearby. Privacy is important, too, Dr. Moorthy says, for when family members just want to have a quiet moment with the baby. For even more access, a new service provided by Angel Eye Camera Systems allows parents to see their baby 24/7 from their laptop, tablet or smartphone.
Access to High-Quality Care
Also crucial for parents is round-the-clock access to physicians, both before and after giving birth, to address any questions or concerns. WellSpan’s teams for Maternal-Fetal Medicine and Neonatology offer expert care while still providing personal attention to each family.
“I’ve worked in many other places — here, it’s very family-centered,” Dr. Moorthy says. “The way we are staffed, we can do our clinical jobs but still talk with families.”
Personal experience also guides the empathy the team feels for families during what can be a high-stress time.
“I make myself open and approachable. Most of us have children ourselves,” says Dr. Moravia, who gave birth to a baby preterm and therefore has unique perspective on patients’ apprehensions.
That approach extends to the WellSpan facilities throughout the surrounding areas. Mothers and babies in Adams, Franklin, Lancaster, Lebanon and York counties have access to WellSpan’s network of services. Advanced care in our NICUs is available in Chambersburg, Ephrata and York.
For more information about WellSpan’s services for high-risk pregnancy, please visit WellSpanSpecialists.org/HighRisk.